Substance Abuse: How large a problem?
“Who is that crazy guy sitting on the bench over there?” How many times have you heard that said aloud, either by friends, coworkers, or just someone walking by on the street? It is something that no matter where you live, or if your town is poor or rich is bound to be heard. Or how many times have you turned on the news to see reports of someone becoming violent and threatening police officers or harassing pedestrians somewhere? These types of stories are only a small percentage of the actual times that the issues are dealt with. People using drugs should not immediately be categorized as criminals and thrown into prison, these can be people ranging from severely mentally ill, to those who have addictions they want to stop but cannot overcome their addiction.
Substance abuse is perhaps the most complicated issues ever faced by the criminal justice system. The issues that come with substance abuse are numerous and are only exacerbated by issues that could be controlled by other means. Different crime control models play a part in how people with substance abuse are dealt with, both with different theories and policies. Perhaps the most immense influence on the issue comes from politicians. Those seeking to enter public office normally make drugs an issue that they guarantee they will be tough on, but is that the best approach? The effect of deinstitutionalization can be traced to as the root for several problems with how mental illness and substance abuse are handled. Persons with a mental illness are more often able to acquire illicit substances to self-medicate, than obtain proper medications due to either dislike of side effects and/or cost of the medication. This problem of self-medicating needs to be addressed and rehabilitation and treatment can work and help, if given the chance. While this may seem like a minor problem, this is only one of many that compound upon themselves to make the issue as a whole much more of a problem than many believe. Like all issues though, a large portion of the issue with any solution or idea to help with this issue comes down to funding. Where will the money come from and what needs to be cut in order to get this to happen.
The issue of substance abuse is a large problem within the criminal justice system. Since deinstitutionalization was implemented many of the people who would be patients in a mental hospital are now on the streets, and not receiving the care they need. Most people with a mental illness are typically nonviolent, but when you add substance abuse into someone’s system the results can be devastating. According to Dinn, Gansler, Moczynski & Fulwiler (2009) “patients with schizophrenia and comorbid substance abuse were much more likely to demonstrate aggressive behavior…than patients with schizophrenia without coexistent substance abuse” (p. 122). What this means is that when you add substance abuse to a pre-existing condition such as schizophrenia, the likelihood of having a violent reaction or outbreak increases. It is not only persons with schizophrenia that are affected by substance abuse, those with bipolar, anti-social, and borderline personality disorders all can utilize illicit substances instead of the proper medication and are prone to violence when this happens.. For this reason many of the mentally ill often have some type of criminal record, which typically is for mostly minor infractions.
There have been many opinions on the cause of substance abuse, and how to go about dealing with people who abuse illicit substances. Over the years the system has changed from a rehabilitative type model, to a retributive model that deals in mandatory minimum sentences, and harsh drug laws. “Steps to reduce illicit drug use have been a high priority for presidents, the Congress, private-sector leadership groups, health professionals, and almost every civic, professional, and political organization in our society” (Blendon & Young, 1998, p. 827). These issues are said to help the public, and are real sticking points when it comes to politicians being elected, but the criminal justice system along with the mental health system are often never consulted or asked their opinions. Practically every political or public organization has a view on what drug laws should be, and the majority of the views are the same. Lock them up, and throw away the key is the cry of many in the public, due to the perceived notion of people lacking self control and ability to stop taking drugs and causing violence. Warner & Kramer (2009) say that “criminal courts have recognized that the sentencing of drug abusing offenders merges a criminal issue (drug offending) with a public health issue (drug addiction)” (p. 91). Showing that while the current model of punishment is still in effect, people are noticing that substance abuse is a real problem not just an excuse for ones actions.
To the criminal justice system, drug use is an ever growing problem that seems to have no other reason than to break the law. The criminal justice departments spend little time looking into the reasoning behind drug abuse, instead focusing on what happened when someone used drugs and what crimes were committed. While police know that drug abuse is a real problem, they are often ill equipped to deal with the treatment or rehabilitation of persons with a substance abuse problem. Some believe that by sending a person to prison that they will stop abusing drugs while inside, but without treatment the odds of them reoffending upon release are great. Supporting that is Warner & Kramer (2009) “traditional sentencing is a revolving door for drug-dependent offenders because, inasmuch as it does not treat the addiction, these offenders will continue to commit crimes to support their drug use” (p. 91). This issue needs to be addressed by policymakers, not necessarily to increase the penalties but a full-scale investigation about it. Without empirical evidence backing the laws, they are nothing more than a sham.
Many of the laws that have been implemented to deal with the problem of substance abuse are more for the benefit of politicians, not a way to help solve the problem. The laws are in effect trying to put a band-aid onto a gunshot wound. These laws will not help solve the issues of substance abuse when the means you are trying to use are insufficient to effect a change. Some of the laws implemented have been met with widespread enthusiasm by the public such as the Rockefeller Drug Laws, mandatory minimum sentencing statutes, and “three strikes” laws, which give someone a life sentence after a third conviction from a felony in some states. Each of these laws or statutes take the ability away from the judges or magistrates to possibly help the offender, and force them to follow the guidelines laid out by the law (Tinto, 2001).
While the public perceives the laws as a helpful means to solve the illegal drug problem, they do little to help the problem with substance abuse. The laws focus on and sentencing the sellers of drugs, yet according to Caulkins & Chandler (2006) “sellers appear to spend about 3.3 months incarcerated per year of active selling” (p. 635). This goes to boost the thoughts of those who believe that the laws should be more punitive towards drug abusers and sellers, seeing how they do not spend what seems to be much time behind bars for their crimes. In the year 2000, roughly 450,000 people were incarcerated due to drug offenses, and even if they all were illicit drug sellers it still only equates too roughly 2 hours behind bars per drug sale (Caulkins & Chandler, 2006). Law enforcement see’s this issue as a real problem because it seems that no matter what they do, even with tougher sentencing laws the ratio of abusers in prison to outside is never enough to make a large dent in the issue of substance abuse. As noted by Poret (2009) “the increasing amount of public resources devoted to repressive drug policies does not succeed in stemming the increase in drug production and consumption” (p. 221). That view has been noted and re-iterated by many but the changes that are implemented to help normally are just as futile as previous measures.
Deinstitutionalization perhaps was one of the lightning rods that accelerated the substance abuse throughout America. Slate (2003) states that “In 1960, more than 500,000 persons resided within state hospitals…current data reveals that there are almost 5 times more persons with mental illness in jails and prisons across America than all state psychiatric hospitals combined” (p. 12). This shows that while the populations of the psychiatric care was being changed from a mainly inpatient philosophy towards a community based one; the numbers of mentally ill began swelling in the criminal justice system. Much of this is/was due to lack of training of police to understand mental illness, which led to arresting those whose behavior appeared erratic. Between 1980 and 1992 this led to over 150% increase in the number of mentally ill persons within jails (Slate, 2003).
In theory the goals of deinstitutionalization were very well thought out given the research that had been done on the matter, and the moral beliefs behind the movement. People believed that the outpatient treatment one could receive would be more humane and effective than locking someone up who had a mental illness. What people failed to account for was the effect freedom would have that was granted to patients. With the ability to stop taking medications that were prescribed to them, without medical supervision many were able to get illicit drugs which in their minds better managed their symptoms. These drugs only served to exacerbate the underlying conditions, most often causing contact with law enforcement.
Shifting the paradigm back towards rehabilitation needs to be the ultimate goal when it comes to substance abuse problems especially with the mentally ill. However, it is the view of the public, that crime is caused by substance abuse, not that the substance abuse is actually a mental illness. In order for the people to change the way that they view the issue of substance abuse, more work needs to be put into informing the public of the research that shows the effectiveness of substance abuse treatment programs. That being so, the issue then becomes who should be eligible for substance abuse treatment rather than prison sentences. Do people who say they do not want treatment have a right to not receive it? Or should people like that be forced, or coerced into a substance abuse treatment program and how effective would they be? (Warner & Kramer, 2009).
While a rehabilitation model is generally better than punitive or retributive, rehabilitation has more perceived weaknesses than the others. Without acknowledging and informing citizens of these issues many will be unwilling to approve of this. First just by its very nature rehabilitation appears weak to outsiders with no knowledge of the programs and how they work. They see people who commit crimes not going to jail to be punished for their actions, instead sent to a cozy easy rehabilitation clinic like celebrities. The public believes that due to the ability of celeb’s to check themselves into and out of rehab for short periods that it is ineffective and nothing more than a ploy to get out of doing things. A second weakness with rehabilitation is that no matter how effective treatment is, it is practically never 100% effective in its goals. Compared to the retributive or crime control model where prison is 100% effective in removing the person from the streets during the imposed prison sentence. If someone is sentenced to rehabilitation they could essentially leave treatment early or fail to complete it which would not happen in prisons.
Treatment of people with substance abuse disorders needs to become the focus of all new drug laws due to the proven effectiveness of rehabilitative treatment. Whether inside jails or out in the community, drug treatment has been proven to work much better than other means. One of the current issues with treatment is the use of heroin, or other injectable opiate based products as opposed to the traditional methadone treatment models. Currently, most treatment is based upon the belief that slowly weaning drug abusers off heroin by switching them to a different medication (methadone). The use of methadone has been shown to work part of the time, and is the most widely accepted and utilized management and treatment for heroin users. According to Kinlock, Gordon, Schwartz, Fitzgerald & O’Grady (2009) findings have “shown that prison-initiated and community-initiated methadone treatment were more effective than Counseling Only in terms of heroin use and treatment entry” (p. 278). The study was meant to determine the differences and benefits between drug treatment and counseling to drug dependent offenders within prison and upon release. These types of studies have been conducted and replicated by other scholars. Results have been relatively similar across the board, mostly noting as Kinlock et al. (2009) “prison-initiated methadone maintenance treatment was associated with greater duration of treatment in the community during the 12 months poop prison release compared to counseling in prison with passive referral at release or counseling in prison with initiation of methadone treatment admission upon release” (p. 282).
While Kinlock et al. focused mainly upon prison based treatments and, one recent study done by Oviedo-Joekes et al. (2009) focused particularly upon the use of heroin in controlled settings overseen by medical staff compared to using methadone as a treatment for heroin abuse. Public perception of these programs is usually poor. They believe that the users should be locked up and that the shock treatment of cutting people off from drugs in prison would cure them just as well as treatment. This is entirely untrue, since just because someone is in jail not only is it possible they never quit using drugs, they have a very high likelihood of returning to drug use upon release without treatment. During this study, participants were divided into one of three groups, oral methadone optimized treatment, receiving injectable diacetylmorphine, and injectable hydromorphone. Studies in Europe have shown that receiving diacetylmorphine, which is the active ingredient in heroin, is often effective at treating chronic opiate dependence (Oviedo-Joekes et al., 2009). Within this study by Oviedo-Joekes et al. they found that those who were chosen within the double-blind trial to receive the diacetylmorphine had a higher likelihood of staying in the treatment, and to curb illegal drug use than people on the oral methadone part of the study (2009).
Another thing learned in the Oviedo-Joekes et al. (2009) study was that not only is the diacetylmorphine treatment effective, upon leaving the trial the researchers “observed an important overall reduction in the money spent on illicit drugs in both groups” (p. 784). Not only does treating persons with heroin dependence under controlled settings improve the success rate of treatment, it also shows a reduction in money spent on drugs overall. This is a key bit of information that should not be overlooked. Those who say that free clinics just give out drugs like methadone and people still get high on other drugs with saved money; the study shows that controlled treatment has multiple desirable effects. Again, by having medical staff overseeing the users injecting themselves, this helped save lives. Some of the users injecting themselves with diacetylmorphine had overdoses which, without medical treatment immediately after would have resulted in their deaths (Oviedo-Joekes et al. 2009). Many of the lessons learned in the Oviedo-Joekes et al. study could be, and should be used to make policy and legislative changes.
These previously cited studies seem to provide the support needed to implement these policy changes, but yet Marsden et al. (2009) reports “long-term effectiveness studies are scarce” (p. 1263). While the studies have not had proven long term reliability, the short term data appears to correlate to long term success not just in the short term. One of the most promising points that Marsden et al. (2009) shows is “by which time clients had completed a mean of 19 weeks’ treatment, more than a third of heroin users were abstaining from heroin” (p. 1268). What needs to be done is a follow up study to determine whether or not the third of patients continue to not use heroin, or whether these programs are just a temporary fix to the problem of substance abuse. If these studies prove to have long term effects that can reduce chronic substance abusers, lawmakers will not be able to deny that funding programs such as these on a large scale would have enormous benefits.
While conceptually implementing a policy that would allow heroin users to be in a sense prescribed heroin as a means of treating their use could work, in practice this would not work well. In a sense people would think that we are giving drug users free drugs to use on the taxpayer’s dollar. This idea would not go over well, and could be political suicide for someone to even suggest it. One weakness in a policy such as this would be medical professionals differing opinions on how to go about treatment, and their willingness to actually prescribe heroin which is on the governments Controlled Substances Act as a banned substance. In and of itself this issue would need to be overcome, since where it stands now as a Schedule I controlled substance means it has no legitimate medical usage and therefore is completely banned with severe penalties for possession and distribution.
One of the most practical issues with drug treatment is the one of funding. Both the criminal justice and mental health system have issues with funding that need to be addressed in order to help with treatment. Legislators, who are the voice of the people, have a hard time justifying spending taxpayer’s money on drug treatment when members of their constituency are clamoring for harsher punishments for substance abusers. Money for the mental health system has not been cut as much recently, but deinstitutionalization cut funding to it by focusing on community based treatments but not funding the community programs. As noted by Aufderheide & Brown (2005) “advocates of deinstitutionalization envisaged that it would result in the mentally ill living more independently with treatment provided by community mental health program” (p. 31). The problem with it then and still now is that the federal government did not provide increased funding for community based treatments, which put the burden on the states and local governments which were unable to meet the increased demands (Aufderheide & Brown, 2005).
Funding continues to be a problem to this day, even though both criminal justice and mental health system consistently request funds to help them with their duties. What needs to be done in the short term is to increase funding to drug treatment policies, pre-trial diversions, and community based treatment. While this will increase costs over the course of a few years, the long term benefits of this type of policy could be enormous. One benefit is the eventual decrease in prison populations that currently are overflowing with those who use drugs and therefore contribute to the increased societal and correctional system costs (French, McCollister, Alexandre, Chitwood & McCoy, 2004). If funding was increased for the diversion and treatment options, this would allow the burden placed upon correctional facilities to be lessened, while reducing recidivism due to drug treatment. Both of these are immense long term benefits that could be achieved through policy implementation.
Another one of the issues that comes up when it comes to treating substance abuse is the effectiveness of treatment, and how to evaluate its effectiveness. If a person does not want to be treated, what difference would coercing a person to get treatment in return for a lessened punishment make (Warner & Kramer, 2009). This quandary is one of the issues that need to be studied before policy changes can be effectively changed. Most people believe that if a person does not want to be rehabilitated, there is no point in attempting to change someone with a substance abuse problem. Empirical studies have shown that utilizing coerced treatment is likely to be proven to be effective in the future and it increased the likelihood a person remained in the treatment (Warner & Kramer, 2009). This idea that you can force someone to rehabilitate successfully is not widely believed by society, and therefore there is not a great push to implement change from the general public.
Persons with mental illnesses as coded in the DSM-IV on Axis I and II are routinely found in jails and prisons across the country. This is one of the lasting issues leftover from deinstitutionalization. Many persons, who normally would have been in a mental hospital prior, are out in the community and are becoming involved with the criminal justice system. Due to there being no credible empirical studies done prior to deinstitutionalization about persons with mental illness inside the correctional system, it cannot be said without doubt that the rates have increased (Lamb & Bachrach, 2001). Even without hard statistics to back up the claim of increased jail populations, it cannot be denied that jails have become de-facto mental health facilities. Some officers know persons with mental illnesses in their locality, whether it is a homeless person with schizophrenia and a substance abuse problem, or someone with a Bipolar disorder self medicating with illicit substances. Therefore for the officers the best plan of action in an effort to help the mental health system is to arrest substance abusers for their own good. By arresting the person it opens the door to treatment, however bad it is, to the person who needs it. People with an Axis II disorder generally had higher rates than Axis I in public intoxication, illegal drug use, and possession of drug paraphernalia (Grella, Greenwell, Prendergast, Sacks, Melnick, 2008).
Another of the main issues when it comes to substance abuse is public knowledge and opinion. It matters not how often people are told of issues, see it on the news, or read about it, most people will not change their minds even when presented with evidence that proves they might be wrong. Both the criminal justice and mental health systems try to raise public knowledge and awareness but go about it in different ways. The criminal justice system utilizes programs such as D.A.R.E., Drug Abuse Resistance Education, to spread knowledge of illegal drugs to students. It is hoped that this knowledge passed on to them when young will translate into not attempting to use those illicit substances later on in life. The mental health system focuses mainly on how illegal drugs may cause more problems to the body psychologically than their illegality.
If the criminal justice system wants to overcome the issue of public knowledge and opinion on drugs the D.A.R.E. program must be reworked. Currently all that the program does is spend money to give children a crash course in illegal drugs, which in some cases just makes them more interested in them than they would be previously. Parents often feel good and put bumper stickers on their car saying that their children have had D.A.R.E. since it sends the “right message” about them supporting the children and the community. In order to turn the potential weakness of the program that could turn kids onto using illegal drugs, the criminal justice system must change how the courses are taught. Just giving the children an overview of the drugs is not effective, but showing them videos of people on drug use or examples of what has happened when people overdose could be a better motivator. Canada has done some work with harm reduction models of policing which have in general turned out to be better than the programs currently available in the USA to reduce substance abuse.
Even with studies showing that drug treatment and pre-trial diversion are effective at reducing substance abuse, the general public is not generally made aware of the issue. Without the general populations acknowledgement, and understanding of this a policy of temporary increased funding to these programs to affect long term gains will never happen. Owing to the fact that any short term increases do not show benefits until years later, many taxpayers do not feel the costs are justifiable. Not only is the aforementioned funding a significant issue, current drug and mental health treatment within the correctional system is also an issue that needs to be addressed by legislators.
When jails and prisons have budget problems, the first things to be removed and or have funding cuts are all the treatment programs that have proven benefits. It is the general held view of the current punitive and retributive policy models that prisons are meant to punish offenders no matter what problems might have led to the crime. Wardens in particular do not see substance abuse as a problem that should be solved or treated with treatment policies, but as an excuse for people to commit crimes. For this reason when the issue of money comes up in prisons, treatments are cut to put money elsewhere. According to Grella, Greenwell, Prendergast, Sacks & Melnick (2008) “ the criminal justice system—either in long-term prison facilities, jail, re-entry programs, or detention centers—is often unequipped to address the treatment needs presented by offenders with CODs[co-occuring disorders]” (p. 386). Not only is there normally a lack of funding, but currently when funded they are not adequately funded to help all inmates in need of assistance.
However the main issues with officers arresting those for minor charges are that it puts a disproportionate number of persons with mental illness in the corrections system. While persons with mental illnesses and/or substance abuse receive treatment when in prison, once they are let out on parole or released treatment normally stops. This issue forms the basis of the revolving door correctional system that many in the public detest. While people acknowledge that the many people just go in and out of jails without any real benefit, yet costing society money, these people do nothing to try to solve the problem. The common public notion that the system is flawed is known, yet people would rather complain and point out the problems, than take the time or effort to solve the problem. This issue is something the politicians should take up or have the criminal justice system spend effort to educate the public on the true costs of these revolving door incarcerations without treatment programs to correct the reason individuals are being incarcerated.
Violence as a result of individuals self medicating with additional mental illnesses is a severe problem to both criminal justice and mental health systems. Many homeless people as previously noted have mental disorders such as schizophrenia, bipolar disorders, and mood and antisocial disorders. With these people being out in the community yet often not receiving proper medical care or medication, the odds of them abusing illicit substances to self medicate is great. For this reason the likelihood of them entering the criminal justice system increases. Due to the co-mingling of mental illness with substance abuse many persons can become violent, which in turn leads to the police interaction and possible arrest.
The issue of violence caused by substance abuse needs to be examined, and then changed to better suit the needs of those with disorders. Public perception of those with mental illness and substance abuse is the main issue that needs to be changed. People believe that using drugs is a personal choice, and not a matter of “necessity” to some. One of the reasons that it can be “necessary” to use substances is that those with mental illness cannot deal with the side effects of the actual medication prescribed to help them. This problem causes them to turn to other substances, illegal ones, in an effort to control their illnesses. Without the public’s support of community based treatment rather than allowing police officers to arrest persons for minor crimes, no change can be implemented.
Already people with mental illnesses are arrested more often for minor offenses than those without mental illness. If someone has a mental illness, including substance abuse, police officers are more likely to take someone to jail in an effort to get the person help, rather than someone who commits the same crime but does not have a mental illness. This option is viewed as the best possible scenario now due to the officers using their discretion when acting, and this may be true now but the issue needs to be changed. One way to change the need for officers to arrest those with mental illnesses in order to get treatment is to add community based housing and treatment for those with mental illnesses. Additionally this requires the community based treatment facilities to be available and adequately funded to allow the influx of the mentally ill persons to be admitted to the programs, along with changes in the mandatory jail terms for those arrested.
A majority of those with a mental illness have trouble finding housing in the community for numerous reasons. Mainly the public does not want to have “crazy” people housed anywhere near them for unnaturally high fears that have little basis in facts. People in the field often agree that one of the most important issues for someone with a mental illness such as schizophrenia is reliable housing. Usually people will be expelled from housing due to lack of compliance with rules and regulations regarding medication, jobs, and other issues. What needs to be done is something in the way of “guilt free” housing. Possibly call it judgment free housing, in the respect that while the housing will obviously have rules and regulations, they will also be lenient towards slip ups. By keeping those with problems in housing, it keeps them off the street and therefore less likely to run into law enforcement, therefore keeping them out of the correctional system. While this is not a foolproof plan, or by no means easy to implement or plan, by solving one of the main issues for homeless mentally ill it would relieve burden on other parts of society. This will also assist the Emergency Medical System with the need to care for those displaced persons on the street, and abuse of Emergency Room resources for mentally ill persons on the street. This is a benefit of keeping mentally ill persons in community based housing and assistance programs.
Police, prisons, and taxpayers will reap the benefits of a policy of helping mentally ill find sustainable housing. Officers will have to expend less resources dealing with the mentally ill, and processing them through the system. Prisons would be able to free up space when the housing program takes hold, and effectively seal the revolving door problem of housing for the persons. The largest benefit would be to the taxpayers who have to spend the money to either house the mentally ill in prisons and pay police to put them there, which according to Aufderheide & Brown (2005) “a seriously mentally ill individual is imprisoned and treated for around $35,000. Prison isn’t the best place for a mentally ill person to be, but it’s better than to just be homeless in the community” (p. 32). The costs for imprisoning and treating the mentally ill are high, whereas housing outside prison in the community can be much more cost effective as well as treatment. While law enforcement and the mental health system both agree that the mentally ill should not be arrested as often as they are but currently that is the best situation that is available.
Overall the problems faced by both the criminal justice, and mental health systems are numerous and can seem overwhelming. The current method of dealing with problems reactively needs to be changed, which will turn our system into one of the best ones anywhere. If the two systems can began to communicate more, share information, and views that are different between the two, then real progress can be made. While communication between the two different groups is essential to progress moving forward, perhaps a three part model could be utilized to even greater benefit.
If the goal is to solve the problem of substance abuse, than not only the criminal justice and mental health systems must be incorporated. Involving the public with the ideas and planning would make it even more effective. For instance, say that the criminal justice and mental health agreed that the best way to help with substance abuse is to create housing and treatment facilities for those suffering from substance abuse. Before any changes in policy would be announced, hold several open forums to answer questions from the public, pass on the knowledge to those who would have to be dealing with the issue indirectly. Being able to remove the pre-existing prejudices of the public and have all three areas working together towards a common goal would eliminate, or help eliminate the fighting that would go back and forth between legislators and the ideas they have. Another name for a policy similar to this would be “harm reduction”, which aims to reduce the social cost related to illegal drug use (Poret, 2009). Policies using the harm reduction model have been implemented in Canada, and to general success. It would be wise to try to implement something similar here, but it needs the public’s approval and essentially money.
From what is known, the issue of substance abuse can seem to be a great mess. So many differing opinions upon what to believe makes people wonder if they should bother trying to change their minds. Whether it is the issues of deinstitutionalization and the effects that it brought upon us, or the different approaches used today to put offenders behind bars. It needs to be understood and widely believed that the way we have handled this issue has been mismanaged and needs further work. Dealing with this is not something that society as a whole cannot sit back and watch to see if it gets better by itself. Politicians need to open their eyes to the truths of what helps people who suffer from mental illnesses when substance abuse is added in to the equation. Without the people with the power realizing that change is needed and necessary we will remain stagnant in this issue, even with the positive research that is coming out now to help. If there was a simple way to solve this issue it would have been found and utilized prior to now, what needs to be done now is hard work, planning, and patience to ensure that this problem is not just left for others to deal with since it is too hard now.
